When plantar fasciitis pain seems intractable, a doctor may recommend injections, extracorporeal shockwave therapy (ESWT), or surgery. These treatments are elective, meaning it is up to the patient to decide whether or not to do them.

See Is Heel Pain Caused by Heel Spurs or Plantar Fasciitis?

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Injections

There are several types of injections offered to treat plantar fasciitis. Steroid injections are by far the most common, though others are growing in popularity.

    Cortisone injections (steroid injection). Plantar fasciitis patients who are in moderate to severe pain and have not responded to treatment may be advised to have a cortisone injection. This steroid will reduce or eliminate inflammatory pain but may have an overall degenerative affect on the protective fatty pads at bottom of the foot.

    Cortisone injections can also weaken the plantar fascia, putting it at an increased risk for rupture. Because of this risk, a patient should talk to a doctor or physical therapist and get advice and approval for any exercising and stretching routine to be done during the weeks following an injection.

    PRP Injections. A platelet rich plasma (PRP) injection uses platelets from the patient’s blood in an attempt to encourage healing in damaged tissue. This treatment requires a blood draw from the patient. Data from recent clinical studies show that PRP injections might be a safe and effective treatment for some people with plantar fasciitis,7,8,9,10 though more study is needed.

    Botox Injections. Recent research suggests that injections of Botox, or Botulinum toxin type A (BTX-A), may be a safe and effective way to relieve plantar fasciitis pain and inflammation.11,12 More study is needed.

If injections do not provide relief from plantar fasciitis, extracorporeal shock wave therapy or surgery may be considered.

Extracorporeal shock wave therapy (ESWT)

There is limited evidence that extracorporeal shock wave therapy (ESWT), sometimes called radial shockwave therapy, may be an effective treatment for plantar fasciitis. It is typically used by patients who want to avoid injections or who have had injections without success.

Extracorporeal shock wave therapy is an outpatient procedure in which mechanical shock waves are administered with a small, hand-held device. Experts theorize that the shockwaves lead to increased blood circulation and metabolic responses that prompt tissue healing.

This treatment may require a series of outpatient appointments. Depending on the strength of the shock waves, this therapy can be uncomfortable or even painful and local anesthesia may be used. While it is generally considered safe, potential side effects include pain, swelling, and unusual or changed sensation, including numbness.

Surgery: plantar fasciotomy

In rare cases, a doctor may advise a patient to consider surgery to treat plantar fasciitis.

    Plantar fasciotomy. The most common surgery is plantar fasciotomy. A surgeon makes an approximately 1.5-inch incision in the heel and then makes precise cuts to release tension in the plantar fascia.

    Endoscopic plantar fasciotomy. This surgery is quite similar to a traditional plantar fasciotomy, but the surgeon accesses the foot through two smaller incisions rather than one large incision. This surgery is less common and requires special equipment and surgical training. Some experts believe endoscopic surgery increases the risk of nerve damage.

Plantar fasciotomy surgeries are successful in the majority of cases but do have potential side effects, such as the flattening of the foot’s arch and nerve damage. Therefore, surgery is recommended only to certain patients whose symptoms have lasted for 12 months or longer and whose pain has not responded to more conservative treatments.

References

  1. O'Malley MJ, Vosseller JT, Gu Y. Successful use of platelet-rich plasma for chronic plantar fasciitis. HSS J. 2013 Jul;9(2):129-33. doi: 10.1007/s11420-012-9321-9. Epub 2013 May 18. PubMed PMID: 24426857; PubMed Central PMCID: PMC3757478.
  2. Shetty VD, Dhillon M, Hegde C, Jagtap P, Shetty S. A study to compare the efficacy of corticosteroid therapy with platelet-rich plasma therapy in recalcitrant plantar fasciitis: a preliminary report. Foot Ankle Surg. 2014 Mar;20(1):10-3. doi: 10.1016/j.fas.2013.08.002. Epub 2013 Aug 16. PubMed PMID: 24480492.
  3. Monto RR. Platelet-rich plasma efficacy versus corticosteroid injection treatment for chronic severe plantar fasciitis. Foot Ankle Int. 2014 Apr;35(4):313-8. doi: 10.1177/1071100713519778. Epub 2014 Jan 13. PubMed PMID: 24419823.
  4. Mukesh Tiwari, Rakesh Bhargava. Platelet rich plasma therapy: A comparative effective therapy with promising results in plantar fasciitis. J Clin Orthop Trauma. 2013 March; 4(1): 31–35. Published online 2013 February 4. PMCID: PMC3880505
  5. Elizondo-Rodriguez J, Araujo-Lopez Y, Moreno-Gonzalez JA, Cardenas-Estrada E, Mendoza-Lemus O, Acosta-Olivo C. A comparison of botulinum toxin a and intralesional steroids for the treatment of plantar fasciitis: a randomized, double-blinded study. Foot Ankle Int. 2013 Jan;34(1):8-14. doi: 10.1177/1071100712460215. PubMed PMID: 23386757.
  6. Díaz-Llopis IV, Rodríguez-Ruíz CM, Mulet-Perry S, Mondéjar-Gómez FJ, Climent-Barberá JM, Cholbi-Llobel F. Randomized controlled study of the efficacy of the injection of botulinum toxin type A versus corticosteroids in chronic plantar fasciitis: results at one and six months. Clin Rehabil. 2012 Jul;26(7):594-606. doi: 10.1177/0269215511426159. Epub 2011 Dec 1. PubMed PMID: 22144721.
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